=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083804298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD A. NICHOLS D P M P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2007
-----------------------------------------------------
Last Update Date | 01/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 LANCASTER DR STE 102
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-481-4000
-----------------------------------------------------
Fax | 817-421-0732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 LANCASTER DR STE 102
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-481-4000
-----------------------------------------------------
Fax | 817-421-0732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/PODIATRY
-----------------------------------------------------
Name | DR. RICHARD A NICHOLS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 817-481-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------